Narcissism – The Shame-Negating Personality

Psychiatric labels have long been criticized for bringing stigma to those afflicted with mental disorders. In the case of narcissistic personality disorder, one glance at the DSM–5 (2013) diagnostic inclusion criteria takes us well beyond stigma. The criteria are a list of outright obnoxious or pejorative descriptors; they are a virtual primer for reasons to avoid or dislike the narcissist. As a clinical psychologist attempting to treat people displaying aspects of narcissistic personality disorder, one of my first tasks is to acknowledge these undesirable qualities that interfere with my patient’s interpersonal relationships, while avoiding succumbing to negative reactions that provoke even further narcissistic defenses.

According to the DSM–5, the essential features of narcissistic personality disorder are “a pervasive pattern of grandiosity . . . , need for admiration, and lack of empathy, beginning by early adulthood and present in a variety of contexts” (American Psychiatric Association, 2013, para. 301.81). Nine diagnostic criteria follow, including grandiosity; preoccupation with fantasies of unlimited success, power, brilliance or beauty; belief that he or she is special; a requirement for excessive admiration; a sense of entitlement; a tendency to exploit others; an absence of empathy; a preoccupation with envy; and an attitude of arrogance. This is, indeed, a daunting list of unpleasant human traits. As a medical analogy, imagine that “vile habits of coughing and breathing” constituted the diagnostic criteria for pneumonia. Not only would pneumonia sufferers feel needlessly condemned, their treatment would likely flounder without an understanding of the medical pathology underlying their symptoms.

My point here is not to dispute that the above behaviors or qualities reliably distinguish an important and valid syndrome of personality organization, but to look deeper into the functions that these qualities serve for the narcissist. Without an understanding of the primary role of the shame emotion, narcissism does seem a puzzling collection of unseemly traits. We are all familiar with the feeling of shame. Unlike guilt, in which we feel regret about an action that caused harm to another person, shame is a private, self-focused experience in which we feel bad, deficient or inadequate. In the parlance of modern psychology, guilt is about doing, while shame is about being.

Imagine we had a phone app capable of graphing daily fluctuations in our self-esteem. For most of us, we would inevitably see shifts from states of relative neutrality to momentary elevation from pride or self-satisfaction in rewarding relationships, accomplishments, or attributes. But there would also be sudden deflections into shameful deflation. As an example of the latter, we might run into a much more successful or accomplished colleague, triggering shimmers of a deep sense of failure or inadequacy, possibly linked to painful childhood experiences. Sometimes even a random thought or reminder might trigger a brief deflection of self-regard. But for most of us, these descents tend to be short-lived and don’t interfere long-term with our ability to function.

The key to shame-related psychopathology such as we see in narcissistic personality disorders is the relative vulnerability of the individual to mental states associated with shame, along with the corresponding degree to which the entire personality structure is organized around defending against shameful experiences (Zaslav, 1998). When I see a patient who seems to operate in state of oblivious immersion in grandiose fantasies, I see a personality organized around the need to neutralize or negate entrance into shameful states of mind. For people on the narcissistic spectrum, contact with the shame experience is rigidly held at arm’s length. For the most part, this is not a conscious choice but a way of being. The narcissist has learned to withdraw from contact with feelings of inadequacy as from the touch of a hot stove.

The classical behavioral descriptors of narcissistic personality make perfect sense when one considers their function in neutralizing shame experiences. Fantasies of grandiosity become a buoying mirror image of a sense of inadequacy. A sense of entitlement goes hand in hand with enhanced self-image—after all, “level of entitlement” is merely a term denoting a person’s innate sense of what someone of his or her worth or standing deserves. In any case, in my own experience, lecturing a patient about what he or she is entitled to is a waste of time. It is the underlying sense of worthiness that is the issue, and this requires deeper exploration.

The patient struggling with anxiety generally does not trigger our disapproval: Anxiety and fear are morally neutral reactions to threat. On the other hand, shame (and its staunch negation) is at its essence a moral matter. We feel embarrassed for and angry with the narcissist. While initially we may be drawn to narcissists out of admiration for their self-confidence and manipulative charm, we recoil when reminded that the narcissist lacks a reciprocal sense of humility and compassion. As mental health practitioners, we are not immune to these reactions, but it is our task to see beyond our countertransference to the fundamental issues with which the narcissist struggles.

The narcissistic patient lives without the ability to experience shame in well-modulated, stable states of mind. These habits of mind have never been learned. When we gradually and tactfully enhance the patient’s ability to tolerate the shameful aspects of his or her experience, we often see a softening of some of the defining aspects of the narcissistic personality. These changes enable us to see beyond the “disorder” to a person struggling to feel more whole and connected to others.

In The Selfishness of Others (2016), author Kristin Dombek cautions against the increasingly casual use of the term “narcissist” as a popular epithet. Perhaps it is also time for mental health clinicians to refine our conversation about narcissism around the shame-negating pathologies that actually drive the disorder.

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